Anxiety disorder: phobia (social, specific, agoraphobia)

Question 1

Define phobia.

Answer 1

Definition of a phobia (Marks)

• Fear out of proportion to the demands of the situation
• It cannot be reasoned away
• It is beyond voluntary control
• Fear leads to avoidance of the feared situation, and can lead to disability

Question 2

How common are phobias? When do they usually begin? Who is most affected?

Answer 2

• F>M (2:1)
• Often starts in childhood (5-9)
• Lifetime prevalence: 5-10%
• Environmental and injury phobias: mid 20’s
• Animals, storms, heights, illness, injury, death

Question 3

What are the general signs of phobia?

Answer 3

• Avoidance
• Fear
• Disability

Question 4

What is the aetiology of phobias?

Answer 4

Genetics: Up to ¾ of affected probands have a 1st degree relative with the same phobia

Phobias may also develop through modelling (i.e. watching a parent) or by information transfer (i.e. being taught to be frightened of something)

Operant / classical conditioning

Question 5

What is the prognosis with phobias starting in childhood vs adulthood?

Answer 5

Simple phobias that originate in childhood continue for many years.

Phobias starting in adult life after stressful events have a better prognosis (70-80% with CBT)

Question 6

Define agoraphobia.

Answer 6

• A fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong.
• Open & confined spaces
• Anxiety in at least 2 of the following: crowds, public places, travelling away from home, travelling alone
• Avoidance of phobic situation must be prominent

Question 7

What may be comorbid in agoraphobia?

Answer 7

Panic attacks common

Similar predispositions to Panic Disorder

Depression in 40%

Question 8

What must you exclude in agoraphobia?

Answer 8

Check that psychological and autonomic sx’s not due to psychotic / delusional thoughts.

Question 9

What are the signs of agoraphobia?

Answer 9

• House bound
• Panic attack
• Dependent on another person

Question 10

What is the prognosis of agoraphobia?

Answer 10

Disabling and crippling, even without panic.

Fluctuating course

Depression 40%

Question 11

Define social phobia.

Answer 11

• Marked fear of being the focus of attention, or fear of behaving in a way that will be embarrassing or humiliating
• Everyday interactions such as pubic speaking, meetings, dates.
• Fear of criticism by others.
• Feeling self-conscious
• Avoidance of phobic situations
• The first episode occurs in a public place, usually without any reason

Question 12

Who is most affected by social phobia? When is the onset?

Answer 12

• F>M (3:2)
• Onset in late teens (17 – 30)
• Continuous course
• 6 month prevalence 2-3/1000

Question 13

What are the signs of social phobia?

Answer 13

• Social withdrawal
• Blushing
• Tremor
• Panic attacks
• Alcohol abuse more common

Question 14

What are the differential diagnoses for social phobia?

Answer 14

• DDx
• Shyness
• Poor social skills
• Anxious personality disorder
• Autism

Question 15

What is the prognosis with social phobia?

Answer 15

• Generally present for life
• Complications: alcohol and drug dependence (usually prescribed)
• Secondary depression

Question 16

What is the management of phobias?

Answer 16

CBT with exposure therapy (typically 12 weeks):

• Done through desensitization
• Hierarchy
• Exposure to stimulus without avoidance behavior
• Allows for habituation
• Weekly sessions + homework

Medication:

• SSRI / Venlafaxine
• Beta-blockers

Benzodiazepines (Should be avoided)